Chamber could back Cadillac tax -- Senate Dems want to move some benefits to 2010 -- H. Fineman: a Snowe vote 'won't make the outcome bipartisan any more than dancing shoes made DeLay Fred Astaire'

By Chris Frates

10/26/09 05:45 AM EDT

EXCLUSIVE: U.S. Chamber of Commerce President Tom Donohue tells Pulse that his organization would support a tax increase on so-called “Cadillac” health plans to help provide coverage for all insured, including illegal aliens, as part of a compromise reform plan. The Chamber, which has been under fire from the White House and its allies for pro-business stance on many issues including health care, has kicked around the idea of putting forth a specific legislative plan business could rally around, Donohue said. But that appears unlikely right now. Donohue says business agrees with the White House on 80 percent of the details under consideration on Capitol Hill, including a mandate that many uninsured Americans get coverage. He said the Chamber is open to considering other tax increases, too. It’s the 20 percent that seems almost certain to keep the Chamber from backing the final bill, however. -- Jim VandeHei

It’s Monday. “Keep your eyes on the road and your hands upon the wheel. We're going to the Pulsehouse. We're gonna have a real good time." (h/t: Herb Kuhn) It’s an Acela series. Game deets below.

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LOOK AHEAD – Senate Majority Leader Harry Reid plans to send several versions of a bill to CBO today and is expected to present them to his caucus tomorrow. Reid knows what he’d like to do, but will wait until today to make final decisions. If he goes with the opt-out, Senate Dems are concerned that the 60 votes needed to clear the first procedural hurdle wouldn’t necessarily translate later to 60 votes in favor of the bill. In the House, Democratic leaders worked their rank and file by phone over the weekend, but have not made any final decisions. Democratic leaders will likely meet Tuesday morning and are expected to hold off on any announcements until after their noon caucus meeting. There's also a chance that Democrats will untie the abortion knot this week. Rep. Lois Capps has been working with freshmen and sophomores to develop language they can endorse. As of now, a compromise rests more with these junior members than it does with pro-life Dems like Rep. Bart Stupak. And last night, the White House posted a blog item to tamp down any talk of a split between Obama and Reid, a move aimed at reassuring liberals worried that Obama favors the more conservative trigger over Reid’s opt-out. -- With Carrie Budoff Brown and Patrick O’Connor

DAN PFEIFFER’S BLOG POST: “The Public Option: Rumor Check -- A rumor is making the rounds that the White House and Senator Reid are pursuing different strategies on the public option. Those rumors are absolutely false. In his September 9th address to Congress, President Obama made clear that he supports the public option because it has the potential to play an essential role in holding insurance companies accountable through choice and competition. That continues to be the President's position. Senator Reid and his leadership team are now working to get the most effective bill possible approved by the Senate. President Obama completely supports their efforts and has full confidence they will succeed and continue the unprecedented progress that is being made in both the House and Senate.”

** A message from GlaxoSmithKline: Many diseases like heart disease, lung disease, diabetes, and some cancers can be prevented or better managed. With the Triple Solution for a Healthier America, we can tackle chronic diseases three ways: Prevention, Intervention, Innovation. **

OUTLINES OF A SENATE BILL – WSJ’s Adamy and Hitt report: “Top Senate Democrats are close to finalizing their health bill and could unveil a measure as soon as early this week that would include stiffer penalties on employers who fail to provide health coverage. Senate leaders plan to submit the bill to the Congressional Budget Office for a cost estimate as soon as Monday, and make the legislation public as soon as Tuesday, according to a person familiar with the negotiations. Details of the legislation could change, but its broad outlines are becoming clear. Employers with more than 50 workers wouldn't be required to provide health insurance, but they would face fines of up to $750 per employee if even part of their work force received a government subsidy to buy health insurance, this person said. A bill passed by the Senate Finance Committee had a lower fine of up to $400 per employee. The bill to be brought to the Senate floor would create a new public health-insurance plan, but would give states the choice of opting out of participating in it, a proposal that Senate Majority Leader Harry Reid of Nevada backed last week. The bill is expected to expand health coverage to tens of millions of Americans by giving low- and middle-income Americans subsidies to offset the cost of insurance, and expanding the Medicaid federal-state insurance program to cover a broader swath of the poor. Most people would be required to buy insurance or pay a fine, though exceptions would be made for those deemed unable to afford it. Also expected are new rules on insurers to prevent them from denying coverage to people with pre-existing health conditions and from dropping customers' insurance once they become ill.”

DEMS PUSHING FOR EARLIER BENEFITS reports POLITICO’s Carrie Budoff Brown: “Democrats are pushing Senate leaders and the White House to speed up key benefits in the health reform bill to 2010, eager to give the party something to show taxpayers for their $900 billion investment in an election year. The most significant changes to the health care system wouldn’t kick in until 2013 – two election cycles away. With Republicans expected to make next year a referendum on health care reform, Democrats are quietly lobbying to push up the effective dates on popular programs, so they'll have something to run on in the congressional midterms. Democrats are anxious to mix the good with the bad since some of the pain would be phased in early, including more than $100 billion in industry fees that critics say could be passed on to consumers. … Under the Democratic wish-list, senior citizens would receive discounts on brand-name drugs next year. Small businesses that provide insurance would see tax credits. And a $5 billion high-risk pool would cover people with preexisting conditions.”

DEMS, MCCAIN OPTIMISTIC ON PUBLIC OPTION reports NYT’s Joseph Berger: “Several Democratic senators voiced optimism on Sunday that Congress would pass a health care bill containing at least the germ of a government-run insurance program. Their expectations were grudgingly seconded by Senator John McCain, the Republican presidential candidate in 2008. ‘I think the Democrats have the votes, and in the House, Blue Dogs bark but never bite,’ Mr. McCain said on CBS’s ‘Face the Nation,’ using the nickname for conservative Democrats. ‘So I don’t think they have a problem over in the House side. In the Senate I think the Democrats are very aware that they don’t want a repeat of the Clinton failure in 1994. So I think it’s very likely they will get something through. But it’s not clear to me what it is.’”

ANOTHER PUBLIC OPTION AD COMING TO MAINE – The Progressive Change Campaign Committee is planning to launch an ad this week that urges Obama to press Sen. Olympia Snowe (R-Maine) to support a public option.

HOSPITAL EXEC BUNDLES BIG FOR DEMS -- The Hill’s Kevin Bogardus: “A vital player in the battle over healthcare reform raised the most campaign contributions for Senate Democrats so far this fall, according to Federal Election Commission (FEC) records. Ken Raske, president and CEO of the Greater New York Hospital Association, collected donations worth more than $152,000 for the Democratic Senatorial Campaign Committee (DSCC) in September alone, according to the latest FEC reports. Raske is an important voice in this year’s healthcare debate. His association, representing more than 300 not-for-profit and public hospitals in New York, New Jersey, Connecticut, and Rhode Island, has spent more than a $1 million on federal lobbying in 2009 so far. Raske was also one of three hospital association representatives invited to the White House in May for a meeting with President Barack Obama and other administration officials to discuss healthcare reform.”

“IF YOU BUILD A COVERAGE MANDATE, WILL THEY COME?” -- WaPo’s Alec MacGillis, on A1: “The question of whether people will follow a government order that they carry health insurance -- an issue that will help determine whether universal health care is a success or costly failure -- will depend on more than the penalty they would pay for refusing, many economists say. This, they say, is the lesson of behavioral economics, a school of thought that holds that people do not necessarily make decisions out of well-reasoned self-interest. It is an approach that has gained a powerful foothold in the Obama White House. … As the behavioral economists see it, compliance will depend not only on the penalties and cost of coverage, but also on the ease of signing up for coverage and whether people can be persuaded that it is a widely accepted social norm. They point to the large number of eligible people who fail to take advantage of Medicaid, food stamps and Pell grants as a sign that perceived inconvenience can keep people from taking steps in their economic interest. By contrast, the Medicare drug benefit program has achieved high enrollment partly because low-income Medicare recipients did not need to apply for subsidies if they already qualified for Medicaid.”

MASS. REFORM BODES WELL NATIONALLY -- NYT columnist Paul Krugman: “To be sure, Massachusetts isn’t fully representative of America as a whole. Even before reform, it had relatively broad insurance coverage, in part because of a large union movement. And the state has a tradition of strong insurance regulation, which has probably made it easier to run a system that depends crucially on having regulators ride herd on insurers. So national reform’s chances will be better if it contains elements lacking in Massachusetts — in particular, a real public option to keep insurers honest (and fend off charges that the individual mandate is just an insurance-industry profit grab). We can only hope that reports that the Obama administration is trying to block a public option are overblown. Still, if the Massachusetts experience is any guide, health care reform will have broad public support once it’s in place and the scare stories are proved false. The new health care system will be criticized; people will demand changes and improvements; but only a small minority will want reform reversed. This thing is going to work.”

AFFORDABILITY STILL A BIG QUESTION -- USA Today’s John Fritze: “The high cost of health insurance premiums would continue to put coverage out of reach for millions even if Congress approves legislation President Obama says is intended to ensure ‘that every American has affordable health care.’ The number of people who remain uninsured will depend on how House and Senate leaders reconcile separate versions of health care legislation to arrive at a final bill. The factors include the size of government subsidies to help low-income families pay for insurance and the scope of penalties that would be charged for those who don't buy a plan. … The non-partisan Congressional Budget Office estimates 17 million Americans would remain uninsured under the Senate Finance Committee's 10-year, $829 billion health care bill. Health experts … say that number would include families who earn too much to qualify for Medicaid but not enough to pay for insurance. Others who could remain uninsured under the Finance Committee bill include people who choose to pay a proposed $750-a-year fine rather than buy coverage and those who are eligible for Medicaid but don't enroll.”

K STREET READY TO TWEAK -- WaPo’s Ceci Connolly: “With a growing sense that Democrats may have the votes to pass health-care reform, many participants are now attempting to shape the components of landmark legislation rather than to defeat it. … Lawmakers, industry executives and lobbyists said over the weekend that this is the moment to exert maximum influence on legislation aimed at refashioning the $2.4 trillion health-care sector. From company-specific minutiae to far-reaching changes in the tax code, it is bargaining season. … The shift into deal-making mode is both good news for President Obama and an indication that the most arduous work is yet to come. Although Democrats are nearing a compromise on a government insurance option, large hurdles remain. The party in power is divided over how to pay for health-care legislation, and it could easily become sidetracked by emotional issues such as abortion. Most important, Democrats are still searching for the right recipe for making insurance affordable for average Americans.”

DEMS WASTING TIME PURSUING SNOWE -- Newsweek’s Howard Fineman: “[T]he pursuit of Snowe is pretty close to obsessive, which is not a good thing either for Democrats or for the prospects of health-care reform worthy of the name. First, Snowe's exaggerated prominence is both the result and symbol of Obama's quixotic and ultimately time--wasting pursuit of ‘bipartisanship.’ In case the White House hasn't noticed, Republicans in Congress are engaged in what amounts to a sitdown strike. They don't like anything about Obama or his policies; they have no interest in seeing him succeed. Despite the occasional protestation to the contrary, the GOP has no intention of helping him pass any legislation. Snowe may very well end up voting for whatever she and Democrats craft, but that won't make the outcome bipartisan any more than dancing shoes made Tom DeLay Fred Astaire. Nor would Snowe's vote mollify the GOP grassroots: they don't think of her as a Republican anyway. … Worse, the pursuit of Snowe isn't uniting Democrats; it is dividing them. … She remains deeply skeptical of a publicly financed alternative to private insurance, in good part because of what she sees as the failure of Maine's version of the idea—and yet some form of a public option is favored not only by most Democrats in Congress but by most of the American people.”

THE GAME: With good pitching from Andy Pettitte, the Yankees finish off the Angels 5-2. The World Series opener is Wednesday with my Phils taking on the Yanks in the Bronx.

** The financial costs associated with chronic diseases are high and rising. But many diseases -- including heart disease, lung diseases, and some cancers -- can be prevented. The Triple Solution for a Healthier America advocates a 3-part approach to improve health and lower costs:

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Chris Frates began covering politics before he was old enough to vote. Since his early days covering town council meetings run by three guys behind a folding table, Frates has been fortunate enough to cover government on every level.

An original Politico, Frates covers the intersection of money, politics and policy inhabited by Washington’s lobbyists and writes about national politics. During the health care reform debate, Frates wrote for the paper and was the lead writer of Live Pulse, the website’s health care reform blog. Frates also founded and wrote Politico Pulse, the popular, daily health reform e-mail briefing that quickly became Washington’s must-read crib sheet.

Before coming to Washington, Frates spent more than four years at The Denver Post where he wrote about state politics. Frates covered the 2004 Democratic takeover of the Colorado statehouse, a forerunner of the political tsunami that would hit Congress two years later, and the 2006 governor’s race.

His work has appeared in The Washington Post, The Boston Globe, The Dallas Morning News and dozens of other publications. Frates has covered three statehouses and numerous campaigns.

His political analysis has been featured on the CBS Evening News, CNN, Fox News, MSNBC, WTOP and many other national and local television and radio programs.

Of all the important people he has interviewed, Frates still counts Mister Rogers among his favorites.